How does heparinizing ports work?

[Ted D]

Dumb nurse working a floor and I just am not clear on how heparinizing these things works. I never use them, but want to understand them. So when you de-access the port, right before you pull the needle w/ tubing out, you push a syringe of heparin in? I get that it's to keep from clotting, but doesn't it just go into the blood stream?

[AGACNPTX]

It also sits in the port. Think of when you prime a cap or tubing with saline.

[westieluv]

You are supposed to remove the dwell heparin with an empty syringe before you use the port the next time to avoid over anticoagulating the patient.

[classicdame, MSN, EdD]

The Infusion Nurses Society standards now state that NS is preferred over heparin to prevent HIT. So yes, you are right, it does affect patient's bloodstream.

[Ted D]

It also sits in the port. Think of when you prime a cap or tubing with saline.

So most of the 5ml of heparin sits in the tubing and is removed along w/ the needle when you de-access, but then just a little bit sits in the port?

[Ted D]

You are supposed to remove the dwell heparin with an empty syringe before you use the port the next time to avoid over anticoagulating the patient.

So in that case when accessing you would prime the tubing with NS, but then attach an empty syringe and pull back 10ml?

[KelRN215, BSN, RN]

So most of the 5ml of heparin sits in the tubing and is removed along w/ the needle when you de-access, but then just a little bit sits in the port?

The prime volume of the tubing is very small. The size of the port determines how much it holds. I work with ports every day and the standard for my patients is to lock them with 500 units of heparin prior to deaccessing. I have never removed the dwell heparin when accessing- that's a facility specific thing.

[Ted D]

The prime volume of the tubing is very small. The size of the port determines how much it holds. I work with ports every day and the standard for my patients is to lock them with 500 units of heparin prior to deaccessing. I have never removed the dwell heparin when accessing- that's a facility specific thing.

So the 500 units would just be injected into their blood stream each time it is accessed?

[oncnursemsn]

I work in ambulatory setting- so we access a ton of ports each day. The 5cc heparin flush (100units/1 ml) is used only when the port is de-accessed and needle removed at end of treatment. Remember, heparin has very short 1/2 life, and the 5mls injected goes into the port and the tubing to the tip in the SVC/RA to prevent clot formation at the tip and throughout the catheter. Our patients treated multiple consecutive days are flushed with saline (needle left in) and not heparin flushed until treatment done, needle removed. We find that heparin flushing ports is sufficient to keep most ports patent if done every 4-6 weeks when port not being used. Dwell space of most ports is approx 2.0 to 2.5mls, and catheter to tip end approx 0.8 to 1.2 mls. A 5 cc heparin flush "injects the patient" with less than 200 units heparin, which is negligible in non HIT patient >50 kg. Hope this helps!

[KelRN215, BSN, RN]

I work in ambulatory setting- so we access a ton of ports each day. The 5cc heparin flush (100units/1 ml) is used only when the port is de-accessed and needle removed at end of treatment. Remember, heparin has very short 1/2 life, and the 5mls injected goes into the port and the tubing to the tip in the SVC/RA to prevent clot formation at the tip and throughout the catheter. Our patients treated multiple consecutive days are flushed with saline (needle left in) and not heparin flushed until treatment done, needle removed. We find that heparin flushing ports is sufficient to keep most ports patent if done every 4-6 weeks when port not being used. Dwell space of most ports is approx 2.0 to 2.5mls, and catheter to tip end approx 0.8 to 1.2 mls. A 5 cc heparin flush "injects the patient" with less than 200 units heparin, which is negligible in non HIT patient >50 kg. Hope this helps!

You don't flush with 10u/mL heparin when left accessed?

[oncnursemsn]

Good question- when I worked pedi, babes under 10kg received the 10 units/1ml heparin for all central lines. Easy strength to remember based on wt, and of course volume wasn't 5 mls!

[KelRN215, BSN, RN]

Good question- when I worked pedi, babes under 10kg received the 10 units/1ml heparin for all central lines. Easy strength to remember based on wt, and of course volume wasn't 5 mls!

I work pedi and EVERYONE with ports (babies, toddlers, school aged children, teenagers) gets 500 u of heparin before being deaccessed. When they stay accessed, they are typically flushed with 20-30 u q 8-12hr. PICCs are 20-30u q 8 hrs and CVLs 20-30 u q 12hr when at home. I know this varies WIDELY between institutions though because, when I worked in the hospital, we had a fellow who came from Australia who was aghast that we sent families home telling them to flush the line BID because over there, they flush their lines once/week... and supposedly have fewer CLABSIs.